微型电动切削器治疗慢性肥厚性鼻炎

我科自 2 0 0 1年 10月开始 ,在鼻内镜下利用微型电动切削系统行功能性下鼻甲微创手术 ,治疗慢性肥厚性鼻炎 ,取得较好效果。报告如下。1　资料与方法1.1　临床资料慢性肥厚性鼻炎患者 4 2例 ,男 2 8例 ,女 14例 ;年龄 16～ 5 8岁 ,平均 38.6岁。病程 2～ 2 0年 ,平均6年。均为下鼻甲肥厚肿胀引起鼻腔堵塞或伴有鼻中隔偏曲。 7例曾行微波治疗 ,4例曾行下鼻甲硬化剂注射 ,3例鼻中隔矫正术或下鼻甲部分切除术后复发。均为长期门诊药物治疗鼻塞症状无改善或加重者。均已排除下鼻甲明显水肿、息肉样变和明显“桑椹样”肥厚改变患者。1.2　手术方…     

鼻内镜下鼻中隔成形术切口的选择

随着内镜鼻外科的不断发展 ,鼻内镜下鼻中隔手术已得到了耳鼻咽喉科医师的普遍认可 ,因此鼻内镜下鼻中隔成形术〔1〕切口的选择愈来愈引起人们的重视。笔者根据鼻中隔偏曲的部位、形态和范围 ,选择恰当的手术切口 ,疗效满意。现总结如下。1　资料和方法1 .1 　 临床资料岁岁 ,平均 2 9岁。Kiillian手术切口 2 5例 ,鼻前庭皮肤“L”形切口 1 6例 ,鼻中隔骨软骨交界处黏膜纵形切口 8例 ,鼻中隔棘或嵴尖部横形切口 1 1例 ,鼻中隔棘或嵴前纵形黏膜切口 6例。 6 6例中有2 8例伴有单组或多组鼻窦炎 (其中 1 0例伴有鼻息肉 ) ,43例伴有下鼻甲肥大…     

腮腺多形性腺瘤28例术后分析

我院自 1 986～ 1 997年共收治腮腺多形性腺瘤2 8例 ,均手术治疗 ,现报告如下。1 　 资料与方法2 8例中 ,男 1 0例 ,女 1 8例 ;年龄 2 2 65岁 ,平均3 9岁。左侧 1 6例 ,右侧 1 2例。腺瘤位于腮腺浅叶者 2 7例 ,位于腮腺深叶者 1例 ,术前均无面神经功能障碍。1 986～ 1 992年 ,采用单纯多形性腺瘤摘除术 6例 ;1 993 1 997年采用经典的保留面神经的腮腺切除术 2 2例 ,其中多形性腺瘤加腮腺浅叶切除术 2 1例 ,多形性腺瘤加腮腺全切除术 1例 ,术中均转移胸锁乳突肌肌瓣覆盖面神经和耳颞神经 ,术中保留腮腺主导管者 1 2例。2 　 结果采用单纯多形…     

YAG激光治疗鼻腔血管瘤

本文自1989年始应用YAG激光手术治疗鼻腔血管瘤83例效果显著,现报道如下。1临床资料1．1一般资料：本组83例中,男33例,女50例。年龄最大者75岁,最小者3岁。病程最长5年,短的1周。发生于鼻中隔的毛细血管瘤53例,发生于下鼻甲25例,中鼻甲5例,均为海绵状血管瘤,以上病例均经病理诊断,瘤体大小不一,米粒大至蚕豆大、龙眼核大不等。可具细蒂或广基,色鲜红或暗红。毛细血管瘤较小,质较软,有弹性,易出血。海绵状血管瘤体较大,基介、质软可压缩,多无包膜,易出血,量多,不易止。小的瘤体一次即除,大的分次激光治疗。1．2．设备…     

双极射频等离子手术系统消融治疗慢性鼻炎60例

慢性鼻炎是一种多发病 ,临床上以鼻塞为主要症状 ,以往多采用硬化剂注射、冷冻、微波、激光等方法治疗 ,均取得一定疗效。我科引进美国安泰公司双极射频等离子手术系统 (ENTecCoblatorTMPlasmaSurgerySystem) ,于 2 0 0 1年 7月 1日～2 0 0 2年 6月 31日治疗慢性鼻炎 60例 ,取得较好疗效 ,报告如下。1　资料与方法1 .1 　 临床资料本组患者 60例 ,男 35例 ,女 2 5例 ;年龄 1 2～80岁 ,平均 30岁。病史 1～ 2 0年 ,平均 3.5年。病情分级 :下鼻甲肿大或肥厚紧贴鼻中隔或鼻底为+ + +级 ,与鼻中隔和鼻底尚有缝隙为 + +级 ,轻度肿大为 +级。…     

鼻部多形性腺瘤的CT表现

目的探讨鼻部多形性腺瘤的CT表现，提高诊断准确性。方法回顾性分析4例经手术病理证实的鼻部多形性腺瘤患者CT表现并复习相关文献。其中男1例，女3例，年龄23～60岁，中位年龄47.5岁；全部患者均行鼻窦CT平扫，其中1例平扫后行增强扫描。结果4例鼻部多形性腺病患者中，1例位于鼻根部，3例位于鼻中隔前部，肿瘤大小为1～3 cm，病变形状1例呈椭圆形，3例呈类圆形，边界均清楚。CT平扫时病灶密度与邻近肌肉组织密度相等，密度不均匀，其中3例病变内部可见裂隙样低密度区，1例病变周围骨质呈轻微压迫性骨质吸收，其病灶内部可见斑点状钙化，增强扫描病灶未见明显强化。结论鼻部多形性腺瘤的CT表现有一定的特征性，有助于临床早期诊断及治疗方案的制定。     

上颌窦根治术13例报告

1 资料与方法 1.1 临床资料男6例,女7例,16～58岁,平均37岁.病程3个月～20年.13例中均有鼻阻,头闷头痛或有黄脓涕,或面颊肿、胀痛,9例为单侧发病,4例为双侧发病.鼻腔检查示5例鼻腔黏膜肥厚,鼻道或嗅裂处有脓性分泌物.6例中鼻甲肥大红肿或息肉样变,鼻副窦X线摄片多提示为慢性炎症,窦腔阴影,2例有球形阴影.     

明胶海绵夹乳胶片隔离法治疗鼻中隔鼻甲粘连54例

各种原因引起鼻甲与鼻中隔相对应粘膜面损伤 ,可造成鼻中隔与鼻甲粘连 ,手术分离后处理不当 ,极易再度粘连。 1 995年至今我们采用明胶海绵夹乳胶片隔离法治疗鼻中隔与鼻甲粘连 54例 ,经 1个月以上观察 ,疗效满意。报告如下。1　资料与方法1 .1 　 临床资料本组 54例 ( 67侧 ) ,男 40例 ( 51侧 ) ,女 1 4例( 1 6侧 ) ;年龄 1 5～ 50岁 ,平均 34岁 ;病程 :术后 1个月～ 2年 3个月。症状 :鼻塞 ,头痛。检查 :54例( 67侧 )鼻中隔与下鼻甲均有不同程度粘连 ,其中伴有鼻中隔偏曲 3例 ,鼻息肉复发 2例 ( 3侧 ) ,粘连侧下鼻甲肥大 6例 ( 6侧 )。造…     

变应性鼻炎并鼻中隔偏曲患者的手术与冷冻治疗

1993年以来 ,我科选择性地对变应性鼻炎(AR)并鼻中隔偏曲患者 2 18例 ,行鼻中隔矫正术及筛前神经分布区域黏膜冷冻治疗 ,效果满意。现报告如下。1　资料与方法1.1　临床资料本组 2 18例符合 1997年海口会议制定的AR诊断标准。其中男 16 6例 ,女 5 2例 ;年龄 18～ 6 5岁 ,平均 31.4岁。病程 3～ 2 8年 ,平均 7.8年。均有常年发作性喷嚏、鼻痒、鼻塞、流清涕等症状 ,抗原皮试和鼻激发试验阳性 ,并有明显的诱因 (如室尘、煤气等 )。全部病例伴有鼻中隔偏曲 ,其中呈“c”型偏曲 116例 ,“S”型偏曲 10 2例 ,同时伴鼻甲肥大 78例 (下鼻甲 5 4例…     

鼻中隔软骨翻瓣法加鼻甲粘膜修补鼻中隔穿孔

1994年 2月～ 2 0 0 0年 6月 ,我们利用残余的鼻中隔软骨以翻瓣法加鼻甲粘膜移植修补鼻中隔穿孔 1 7例 ,效果满意 ,现介绍如下。1　资料与方法1 .1　临床资料鼻中隔穿孔 1 7例 ,男 1 2例 ,女 5例 ;年龄 2 5～5 0 (平均 38.2 )岁。主要临床表现为不同程度鼻出血、干鼻痂、干燥感、不适感等 ,4例有哨音和精神压抑感。引起穿孔原因 :鼻外伤 2例 ,鼻中隔手术 7例 ,鼻部冷冻、微波治疗不当 5例 ,长期溃疡感染 1例 ,不明原因 2例。穿孔形状 :圆形 4例 ,椭圆形 1 1例 ,裂隙状 2例。穿孔直径 0 .3～ 1 .5ｃｍ。1 .2　手术方法术前充分估计残余的鼻中…     

Trends in blunt laryngotracheal trauma in children

Objective

To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.

Design

Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.

Setting

Tertiary medical center.

Patients

Thirty-five patients were identified with major laryngotracheal trauma.

Main outcome measures

Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.

Results

Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.

Conclusions

In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.     

HLA associations in otosclerosis in Japanese patients

Otosclerosis is a disease of the otic capsule that is caused by abnormal resorption and redeposition of bony tissue. Sixty-two unrelated Japanese patients exhibiting clinical otosclerosis were typed for HLA-A, -B,-C antigens. Twenty-one of the patients were also typed for DR antigens. The frequency of HLA-Aw33 was significantly higher in otosclerosis patients than in the control group (24.2% vs 9.5%). This finding suggests that the presence of HLA-Aw33 antigens may be related to an increased susceptibility to otosclerosis or to its clinical outcome.     

Changes in immunologic response in tonsillectomized children. I Immunosuppression in recurrent tonsillitis

The possible immunoregulatory role of the tonsils was studied by determining immunoglobulins IgG, A, M, E and factors C'3, C'4 and PFB of the complement system before and after tonsillectomy. The synthesis in vitro of IgG and IgM by lymphocytes stimulated with pokeweed mitogen was also measured. There were statistically significant differences between pre and post-operative levels of serum IgG, IgA and IgM, which decreased after surgery. Practically no change in the mean values of IgE and no significant differences in the levels of serum C'3, C'4, and PFB, were found. The in-vitro synthesis of both immunoglobulins (IgG, IgM) by lymphocytes increased significantly after tonsillectomy. Our results suggest that not only does tonsillectomy have no counterproductive effect on the immune system, but that, on the contrary, it seems to improve the immune response, since it appears to unblock the suppression to which the immune system was subject.     

Immunotype findings in macrophages in aural cholesteatomas

Summary Since a heavy cellular infiltrate is seen in the stroma of most aural cholesteatomas, we attempted to characterize this cell population in more detail using monocyte/macrophage-specific monoclonal antibodies. KiM1+ (specific for CD 11c antigen, the 150kDa -chain of a leukocyte integrin), and KiM6+ phagocytes were present in two- or fourfold higher numbers in the stroma of the six excised cholesteatomas than in the control tissues. Since the stroma of the cholesteatoma is devoid of microvessles, the typical perivascular localization of dermal macrophages was not seen in the cholesteatomas studied. The density of the macrophages in the normal ear skin was much higher in the upper dermis than in the lower dermis. In the cholesteatomatous specimens, the phagocytes were evenly scattered within the connective tissue and the cellular infiltrate. In contrast to diseased skin, no Mac 387+ macrophages were detected in the cholesteatomas. A great number of phagocytic cells closely resembling dermal macrophages was found in the stroma of the cholesteatomas and probably contributes to an active autoimmune process. Offprint requests to: B. Negri